In patients with chronic alcohol use disorders and severe heart failure prognosis is poor, since continued alcohol abuse results in refractory congestive heart failure. Death might also be sudden due to arrhythmias, heart conduction block, and systemic or pulmonary embolism. https://ecosoberhouse.com/ In these patients, only early and absolute abstinence of alcohol can reverse myocardial dysfunction [56, 57, 126] which in a historic study by McDonald and Burch was achieved with prolonged bedrest for several months without further access to alcoholic beverages.
Risk factors
- For instance, healthcare professionals can carry out a stress test or heart catheterization to rule out coronary artery disease (CAD), which is another cause of cardiomyopathy.
- You should also follow your doctor’s guidance and advice on any treatments you receive.
- In the 16th century Paracelsus Theophrastus Bombastus from Hohenheim used this term for distilled liquor and called it alcohol [15].
- All previous mechanisms can induce myocyte apoptosis through the induction of mitochondrial damage and oxidative stress [12].
- The ‘Quebec beer drinkers’ cardiomyopathy’ was related to cobalt supplementation to beer that was made in the past.
Increased cardiac output due to hyperdynamic circulation, left ventricular dysfunction (systolic and diastolic), and certain electrophysiological abnormal findings are pathophysiological features of the disease. The underlying mechanisms might include the impaired β‑receptor and calcium signaling, altered cardiomyocyte membrane physiology, elevated sympathetic nervous tone and increased activity of vasodilatory pathways [44]. In pathophysiological terms, heart failure in liver cirrhosis belongs to the hyperdynamic cardiomyopathies. Ethyl alcohol has detrimental effects on myocardial metabolism; nevertheless, the pathogenetic mechanisms of alcoholic cardiomyopathy remain uncertain. Reactive oxidative metabolites generated from the biotransformation of ethanol are thought to lead to lipid peroxidation of myocytes and oxidation of protein thiols.
Clinical work-up for alcoholic cardiomyopathy
- It took almost 60 years before further attention was paid to the complex interaction between the heart and the peripheral vasculature in various cross-sectional and prospective epidemiologic studies, which have empirically confirmed this early report.
- The population was divided into 3 groups according to their intake volume during the follow-up period.
- According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), AUD is a brain disorder that doctors characterize by the inability to stop or control alcohol consumption.
- The natural course of ACM is mainly related to the degree of persistence in alcohol consumption and the individual biological adaptive response [2,20,41,56,81].
Once doctors have found this, they will look for the cause of the weakened heart. The mainstay of management is providing support, resources including but not limited to alcoholic anonymous and encouragement for alcohol abstinence and address underlying stressors if any which requires assistance from nursing staff and pharmacy. The key to diagnosis is a personal history of chronic heavy alcohol use and the absence of other etiologies. Alcohol-related cardiomyopathy is a type of dilated cardiomyopathy, which is when your heart’s shape changes because its muscles are stretching too much.
- However, it’s more likely to happen in people with alcohol use disorders or who have genetic mutations that cause them to process alcohol more slowly.
- At histological evaluation, dilatation, myofibrillar necrosis and fibrosis are typically present, with a reduction of myofibrils and giant mytochondria [3].
- In a subsequent study using electron microscopy, the authors found histological features that could be superimposed onto those found in hearts that had suffered hypoxia, anoxia or ischemia[43].
- The German word for it is Kieselguhr, a beige powder made up of the skeletons of diatoms.
Organ-Specific Toxicologic Pathology
- Ethyl alcohol has detrimental effects on myocardial metabolism; nevertheless, the pathogenetic mechanisms of alcoholic cardiomyopathy remain uncertain.
- The relationship of alcohol with heart disease or dementia is complicated by the fact that moderate alcohol consumption was shown not only to be detrimental but to a certain degree also protective against cardiovascular disease [14] or to cognitive function in predementia.
- Through a thematic synthesis, we identified common trends, knowledge gaps, and emerging research areas related to ACM.
The only factor to predict a poor outcome was the duration of symptoms before admission. Finally, it is worth stressing that a large majority of studies on the physiopathology and prognosis of ACM were conducted some years ago, prior to the development of our current understanding regarding the role of genetics in DCM[67]. According to recent data, a genetic form of DCM could be present in up to 50% of idiopathic DCM cases, and other specific forms of DCM such as peripartum cardiomyopathy have been shown to have a genetic basis in a significant number of cases[68]. It is therefore possible that patients with ACM could also harbour a genetic substrate that predisposes them to this form of cardiomyopathy. Finally, it should be noted that a large majority of studies on the long-term prognosis of ACM used the cut-off point of 80 g/d for a minimum of 5 years to consider alcohol as the cause of DCM. Since those initial descriptions, reports on several isolated cases or in small series of patients with HF due to DCM and high alcohol intake have been published[15-17].
Acute vs. chronic
Acetaldehyde produced in the liver from metabolism via alcohol dehydrogenase may also reach the heart and produce adverse effects. It has been difficult to reproduce experimentally, except for the pig, until recent studies using a liquid alcohol-containing diet in a metallothionen (MT) knockout mouse. MT is a zinc regulatory protein with release of zinc under oxidative stress. The addition of zinc to the diet prevented the occurrence of cardiac fibrosis but not hypertrophy.
First, we devised a search strategy to retrieve relevant articles from PubMed. Next, we established inclusion and exclusion criteria to determine the eligibility of articles. Inclusion criteria encompassed articles that focused on ACM or the relationship between alcohol abuse and cardiac dysfunction, involved human subjects or relevant animal models, were written in the English language, and were published within the last 10 years. Meanwhile, we excluded duplicates, case reports, letters, editorials, and reviews not specifically addressing ACM. We then proceeded with screening and selection based on the titles and abstracts of the initial search results.
Cardiovascular and Skeletal Muscle Systems
We reviewed the effects of ethanol on the cardiovascular system in 1996 [15], including aspects of inflammation [16], rhythm disturbances [17], and hypertension [18]. In 2001 we updated the data on the ambivalent relationship between alcohol and the heart [19] and in 2008 added new evidence on a larger cohort of patients with different forms of cardiomyopathy and increased alcohol intake from the German competence network on heart failure [20]. The achievement of total alcohol abstinence represents the most effective strategy for the treatment of alcohol-induced ogan damage, including alcoholic cardiomyopathy, in order to promote the recovery of left ventricular dysfunction [4,11]. However, the limit between reversible and non-reversible damage, in other words the “point of no-return”, is currently not known [12]. Alcohol (ethanol) is contained in a number of beverages consumed all over the world since ancient times. The acute ingestion of large amount of alcohol as well as chronic alcohol abuse induce toxic effects to all organs and tissues [7], particularly to central nervous system, liver and heart [8,9].
Various pathophysiological mechanisms have been postulated in the development of cardiomyopathy however one key factor undergoing active research is the role of genetic mutation and susceptibility to develop cardiomyopathy. The preponderance of data suggests that drinking one to two drinks in men and one drink in women will benefit the cardiovascular system over time. Moderate drinking below that threshold might even reduce the incidence of coronary artery disease, diabetes, and heart failure.
